Yaws (cont.)

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How is yaws treated?

Treatment of yaws is simple and highly effective. Penicillin G benzathine given IM (intramuscularly) can cure the disease in the primary, secondary, and usually in the latent phase. Penicillin V can be given orally for about seven to 10 days, but this route is less reliable than direct injection. Anyone allergic to penicillin can be treated with another antibiotic, usually erythromycin, doxycycline, or tetracycline. Tertiary yaws, which occurs in about 10% of untreated patients five to 10 years after initially getting the disease, is not contagious. The tertiary yaws patient is treated for the symptoms of the chronic conditions (altered or destroyed areas in bones, joints, cartilage, and soft tissues) that develop as a result of the infection. There is no vaccine for yaws.

Why is yaws a serious problem?

Yaws is a major public-health threat in the tropics. Tropical regions in Central and South America, Africa, Asia, and Oceania are all at continuing risk for yaws. A high percentage of children in such areas can be infected. Transmission of the disease is facilitated by overcrowding and poor hygiene, and yaws tends to be more prevalent in poor areas. In addition to making young children sick, approximately 10% of untreated children develop into young adults with deformities that are severely debilitating in the tertiary-yaws phase. For example, some patients develop destructive ulcerations of the nasopharynx, palate and nose (termed gangosa), painful skeletal deformities, especially in the legs (termed saber shins), and other soft-tissue changes (gummas, inflammatory cell infiltration). See the second and third references in More Information section (listed below) for images of patients with yaws.

Yaws can be completely eradicated from an area by giving penicillin or another appropriate antibiotics to everyone in the population. This may, unfortunately, cost more than a poor country can afford. From 1950-1970, a worldwide effort to eradicate yaws was begun and made progress in reducing the approximately 50 million worldwide cases; after its end, yaws has seen a resurgence. In the 1990s, attempts to eliminate yaws started again, with limited success as the effort is not worldwide or coordinated but done by individual countries. The WHO (World Health Organization) in 2007 reported about 2.5 million cases worldwide but freely admits their data is faulty, as most countries do not calculate the prevalence of yaws. WHO estimates that about 460,000 new cases of yaws occur each year.